The aim of this study was to establish the relative safety and balance of risks for antidepressant treatment in older people.
The cohort study included 60,746 patients aged 65 years and over diagnosed with depression. The study was based in 570 general practices in the UK supplying data to the QResearch database.
The study objectives were to:
- determine relative and absolute risks of predefined adverse events in older people with depression, comparing classes of antidepressant drugs:
- tricyclic and related antidepressants (TCAs)
- selective serotonin reuptake inhibitors (SSRIs)
- monoamine oxidase inhibitors (MAOIs)
- other antidepressants
- commonly prescribed individual drugs with non-use of antidepressant drugs
- directly compare the risk of adverse events for SSRIs with TCAs;
- determine associations with dose and duration of antidepressant medication;
- describe patterns of antidepressant use in older people with depression; and
- estimate costs of antidepressant medication and primary care visits.
There were 13 predefined outcome measures:
- all-cause mortality
- sudden cardiac death
- suicide
- attempted suicide/self-harm
- myocardial infarction
- stroke/transient ischaemic attack (TIA)
- falls
- fractures
- upper gastrointestinal bleeding
- epilepsy/seizures
- road traffic accidents
- adverse drug reactions
- hyponatraemia
Here’s what the study found:
- The associations with the adverse outcomes were significantly different between the classes of antidepressant drugs for seven outcomes
- SSRIs were associated with the highest adjusted hazard ratios (HRs) for falls [1.66, 95% confidence interval (CI) 1.58 to 1.73] and hyponatraemia (1.52, 95% CI 1.33 to 1.75)
- The group of other antidepressants was associated with the highest HRs for all-cause mortality (1.66, 95% CI 1.56 to 1.77), attempted suicide/self-harm (5.16, 95% CI 3.90 to 6.83), stroke/TIA (1.37, 95% CI 1.22 to 1.55), fracture (1.63, 95% CI 1.45 to 1.83) and epilepsy/seizures (2.24, 95% CI 1.60 to 3.15) compared with when antidepressants were not being used
- TCAs did not have the highest HR for any of the outcomes
- There were also significantly different associations between the individual drugs for seven outcomes, with trazodone, mirtazapine and venlafaxine associated with the highest rates for several of these outcomes
- The mean incremental cost (for all antidepressant prescriptions) ranged between £51.58 (amitriptyline) and £641.18 (venlafaxine) over the 5-year post-diagnosis period.
The authors concluded:
This study found associations between use of antidepressant drugs and a number of adverse events in older people.
There was no evidence that SSRIs or drugs in the group of other antidepressants were associated with a reduced risk of any of the adverse outcomes compared with TCAs; however, they may be associated with an increased risk for certain outcomes. Among individual drugs trazodone, mirtazapine and venlafaxine were associated with the highest rates for some outcomes. Indication bias and residual confounding may explain some of the study findings.
The risks of prescribing antidepressants need to be weighed against the potential benefits of these drugs.
CAC Coupland, P Dhiman, G Barton, R Morriss, A Arthur, T Sach and J Hippisley-Cox. A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database (PDF). Health Technology Assessment 2011; Vol. 15: No. 28.
So the summary is:- and this is good, but it does not detail the adverse events in older people, like 95% falls. WHY? or rather WHY NOT? Who funded this research?
‘The authors concluded:
This study found associations between use of antidepressant drugs and a number of adverse events in older people.
There was no evidence that SSRIs or drugs in the group of other antidepressants were associated with a reduced risk of any of the adverse outcomes compared with TCAs; however, they may be associated with an increased risk for certain outcomes. Among individual drugs trazodone, mirtazapine and venlafaxine were associated with the highest rates for some outcomes. Indication bias and residual confounding may explain some of the study findings.
The risks of prescribing antidepressants need to be weighed against the potential benefits of these drugs.’
ON a personal note, I was subject to lots of falls for a while, can’t say what drugs I was on at the time, just would fall over in the street. Just like that.
But now, I do not fall, but I am very aware of making sure that I balance correctly. In other words, I always cross the road at crossings, when the light shows for pedestrians, and sometimes it changes too quickly, and then also, when I walk I look at the pavement to make sure it is OK to step on, so that I know if there is a hill to negotiate or even a paving stone. I recently fell over a paving stone in the borough where I live and notified the council to repair the stone so nobody else fell over and all they did was send me claim forms – so I could make a claim against the council. Surely it would be a claim against the drug company, but I am not interested in making claims, I want to make sure that other people get better treatment in their old age, when they are on psychiatric drugs.
So Mental Elf what can you do about these falls that people have?
The most frequent reason for people being taken into nursing homes is falling. Most falling is in the ankles. If you have proper ankle health, then when you start to topple over the muscles, tendons, etc., in your ankles pulls you back upright. There is a simple exercise for this: twice a day, rise up on your toes 25 times. When you can do that, then start doing it on one foot. You’ll stop falling.
On the direct subject of the article, it sucks and I’m sorry the Mental Elf posted it. DRUG THERAPY WAS NOT COMPARED TO TALK THERAPY! Human beings–particular old human beings–need people to talk to but don’t have them. Talk therapy does not cause falls, heart attacks, fractures, etc. The study is not based on human values and should not be reported out or further publicized by anyone.